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This position is located in St Louis MO. Not a remote location position

 

 

Responsible to lead multiple teams of clinicians charged with promoting quality member outcomes, to optimize member benefits, and to promote effective use of resources. Primary duties may include, but are not limited to: Ensures adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost effective. Areas managed may include utilization management, case management, disease management and demand management. May also manage appeals for services denied. Hires, trains, coaches, counsels, and evaluates performance of direct reports. Requires 5-7 years acute care clinical experience; or any combination of education and experience, which would provide an equivalent background. Current active unrestricted RN license to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States preferred. Prior management experience required. The following are level distinctions not required for posting. This level typically reflects an experienced manager, one managing more than one function, a manager with a larger span of management to include lower-leveled managers, or one providing clinical oversight for a large segment of the business or a business unit. For URAC accredited areas, the following applies: 5-7 years of experience in a health care environment including management experience or of any combination of education and experience, which would provide an equivalent background. BS degree preferred. Current active unrestricted RN license to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States required.For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
AnEqualOpportunityEmployer/Disability/Veteran

Hiring Manager preferred qualifications:

 

Responsible leading multiple teams of clinicians charged with promoting quality member outcomes, to optimize member benefits, and to promote effective use of resources. Primary duties may include, but are not limited to:
  • Ensures adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost effective.
  • Manages areas which may include utilization management, case management, disease management and demand management.
  • Participates in client presentations and clinical assessment with third party vendors
  • Monitors performance guarantees and process improvement activities to meet goals
  • Implements new clinical teams and workflows to support business needs
  • Work cross functionally with other clinical and account management teams
  • May also manage budget and special projects.
  • Ensures adherence to all contract, regulatory and accreditation requirements.
 
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.
  • Current unrestricted RN license in MO is required.
  • Requires a BS in a related health care field or nursing
  • 5 years of experience in a health care/delivery environment including management experience; or any combination of education and experience, which would provide an equivalent.
  • MS or advanced degree in a clinical nursing specialty, business or healthcare-related field preferred.
 
This position is location in St. Louis, MO. Relocation is open for discussion
 

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